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Freud’s Cocaine Years

In 1879 cocaine began to be used to treat morphine addiction. Cocaine was introduced into clinical use as a local anesthetic in Germany in 1884, about the same time as Sigmund Freud published his work Über Coca, in which he wrote that cocaine causes:

“Exhilaration and lasting euphoria, which in no way differs from the normal euphoria of the healthy person. You perceive an increase of self-control and possess more vitality and capacity for work. In other words, you are simply normal, and it is soon hard to believe you are under the influence of any drug. Long intensive physical work is performed without any fatigue. This result is enjoyed without any of the unpleasant after-effects that follow exhilaration brought about by alcoholic beverages. No craving for the further use of cocaine appears after the first, or even after repeated taking of the drug.”

On April 21, 1884, a 28-year-old researcher Freud composed a letter to his fiancée, Martha Bernays, telling her of his recent studies: “I have been reading about cocaine, the effective ingredient of coca leaves,” Sigmund Freud wrote, “which some Indian tribes chew in order to make themselves resistant to privation and fatigue.”

On April 24, 1884, Sigmund Freud ordered his first gram of cocaine from the local apothecary.

Woe to you, my Princess, when I come... you shall see who is the stronger, a gentle girl who doesn't eat enough or a big wild man who has cocaine in his body.

― Sigmund Freud, Letter to his fiancée, Martha Bernays (2 June 1884)

Freud’s cocaine use began, in fact, with tragedy, “the anguished death of one of his dearest friends,” writes The New York Times in a review of Markel’s book:

[T]he accomplished young phsyiologist Ernst von Fleischl-Marxow, whose morphine addiction Freud had tried to treat with cocaine, with disastrous results. As Freud wrote almost three decades later, “the study on coca was an ­allotrion” — an idle pursuit that distracts from serious responsibilities — “which I was eager to conclude.”

As a medical researcher, Freud was an early user and proponent of cocaine as a stimulant as well as analgesic. He believed that cocaine was a cure for many mental and physical problems, and in his 1884 paper "On Coca" he extolled its virtues. Between 1883 and 1887 he wrote several articles recommending medical applications, including its use as an antidepressant. He narrowly missed out on obtaining scientific priority for discovering its anesthetic properties of which he was aware but had mentioned only in passing. (Karl Koller, a colleague of Freud's in Vienna, received that distinction in 1884 after reporting to a medical society the ways cocaine could be used in delicate eye surgery.) Freud also recommended cocaine as a cure for morphine addiction. He had introduced cocaine to his friend Ernst von Fleischl-Marxow who had become addicted to morphine taken to relieve years of excruciating nerve pain resulting from an infection acquired while performing an autopsy. His claim that Fleischl-Marxow was cured of his addiction was premature, though he never acknowledged he had been at fault. Fleischl-Marxow developed an acute case of "cocaine psychosis", and soon returned to using morphine, dying a few years later after more suffering from intolerable pain.

The application as an anesthetic turned out to be one of the few safe uses of cocaine, and as reports of addiction and overdose began to filter in from many places in the world, Freud's medical reputation became somewhat tarnished.

After the "Cocaine Episode" Freud ceased to publicly recommend use of the drug, but continued to take it himself occasionally for depression, migraine and nasal inflammation during the early 1890s, before discontinuing in 1896. In this period he came under the influence of his friend and confidant Fliess, who recommended cocaine for the treatment of the so-called nasal reflex neurosis. Fliess, who operated on the noses of several of his own patients, also performed operations on Freud and on one of Freud's patients whom he believed to be suffering from the disorder, Emma Eckstein. The surgery proved disastrous. It has been suggested that much of Freud's early psychoanalytical theory was a by-product of his cocaine use.

“I was making frequent use of cocaine at that time ... I had been the first to recommend the use of cocaine, in 1885, and this recommendation had brought serious reproaches down on me.” ― Sigmund Freud, The Interpretation of Dreams